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Journal of Voice : Official Journal of... Sep 2023The purpose of this study is to review the current literature on the effect of hypovitaminosis D on voice. (Review)
Review
OBJECTIVE
The purpose of this study is to review the current literature on the effect of hypovitaminosis D on voice.
STUDY DESIGN
Narrative review.
METHODS
The literature search from electronic databases included PubMed/MEDLINE, EMBASE, SCOPUS, and Google Scholar. Search terms included voice, voice quality, voice disorders, larynx, laryngology, acoustic analysis, vitamin D, calcitriol, cholecalciferol, vitamin D deficiency, and vitamin D insufficiency. All studies on patients with vitamin D deficiency, which included subjective and objective voice assessments, were reviewed.
RESULTS
A total of 39 studies were retrieved. Only four studies met the above-mentioned inclusion criteria and hence were included in this review. The total number of subjects analyzed was 466. The subjective voice outcome measures used were the Voice Handicap Index-10 (VHI-10), self-reported phonatory symptoms, and the GRBAS scale. Objective voice outcome measures included fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, maximum phonation time, and dysphonia severity index.
CONCLUSION
Vitamin D deficiency has no significant effect on laryngeal muscles. There was no statistically significant difference in VHI-10 score, self-reported dysphonia, perceptual voice evaluation scores, or any of the acoustic measures between those with or without vitamin D deficiency.
PubMed: 37661522
DOI: 10.1016/j.jvoice.2023.08.004 -
CoDAS 2023To investigate whether there are differences in cepstral and spectral acoustic measures between women with behavioral dysphonia with and without laryngeal lesions and...
PURPOSE
To investigate whether there are differences in cepstral and spectral acoustic measures between women with behavioral dysphonia with and without laryngeal lesions and verify whether there is a correlation between such measures and the auditory-perceptual evaluation of voice quality.
METHODS
The sample comprised 78 women with behavioral dysphonia without laryngeal lesions (BDWOL) and 68 with behavioral dysphonia with laryngeal lesions (vocal nodules) (BDWL). Cepstral peak prominence (CPP), cepstral peak prominence-smoothed (CPPS), spectral decrease, and H1-H2 (difference between the amplitude of the first and second harmonics) were extracted. They were submitted to the auditory-perceptual evaluation (APE) of the grade of hoarseness (GH), roughness (RO), breathiness (BR), and strain (ST).
RESULTS
BDWL women had higher H1-H2 values and lower CPP and CPPS values than BDWOL women. More deviant voices had lower CPP and CPPS values. Breathy voices had lower CPP and CPPS values and higher H1-H2 values than rough ones. There was a weak negative correlation between CPP and RO, a moderate negative correlation with GH, and a strong negative correlation with BR. CPPS had a moderate negative correlation with GH, RO, and BR. H1-H2 had a weak positive correlation with BR. There was a weak positive correlation between spectral decrease and ST.
CONCLUSION
H1-H2, CPP, and CPPS were different between BDWOL and BDWL women. Furthermore, cepstral and spectral measures were correlated with the different APE parameters.
Topics: Humans; Female; Animals; Dysphonia; Speech Acoustics; Voice Quality; Acoustics; Hominidae; Speech Production Measurement
PubMed: 37970895
DOI: 10.1590/2317-1782/20232022327pt -
Journal of Voice : Official Journal of... Nov 2023Atraumatic laryngeal fractures are extremely rare and are most commonly provoked by sneezing or coughing. Only seven cases have been described in medical literature, and...
INTRODUCTION AND AIM
Atraumatic laryngeal fractures are extremely rare and are most commonly provoked by sneezing or coughing. Only seven cases have been described in medical literature, and only one case described a fracture after swallowing. We present two cases of atraumatic laryngeal fracture after swallowing.
CASE REPORT
A 37-year-old male presented to the outpatient ENT clinic with severe dysphonia and odynophagia. He reported feeling a crack in the throat after swallowing with a flexed head. The patient's physical examination showed diffuse swelling and tenderness over the thyroid cartilage without subcutaneous emphysema. Flexible nasolaryngoscopy showed a large right true vocal fold hematoma with normal vocal fold movement. Computed tomography (CT) showed a fracture of the thyroid. Treatment consisted of corticosteroids and pantoprazole. Two years later he presented again at the emergency department with extreme odynophagia after suffering a knee punch on the larynx. CT showed a new fracture line, slightly off midline to the left in the thyroid cartilage. A 42-year-old male presented at the emergency department with odynophagia, dysphonia, and fever after feeling a crack in the throat during forceful swallowing in an extended neck position. Physical examination demonstrated a painful thyroid cartilage with subcutaneous emphysema. Flexible nasolaryngoscopy was normal but CT scan showed a slightly displaced fracture line of the median thyroid cartilage. Complaints gradually disappeared with conservative treatment with corticosteroids and antibiotics.
CONCLUSION
Congenital anomalies by abnormal mineralization and ossification could lead to focal weakness of the thyroid cartilage and thus predispose to non-traumatic fractures. The double triad of odynophagia, dysphagia, and dysphonia after sneezing, coughing or swallowing should raise the physician's attention to the possibility of thyroid cartilage fracture, especially after feeling or hearing a crack. Further investigation is obligatory with high-resolution CT of the neck and examination by an ENT specialist.
Topics: Male; Humans; Adult; Sneezing; Dysphonia; Laryngeal Diseases; Thyroid Cartilage; Adrenal Cortex Hormones; Subcutaneous Emphysema
PubMed: 34294489
DOI: 10.1016/j.jvoice.2021.05.022 -
The Laryngoscope Jan 2024To evaluate spasmodic dysphonia patients' perception of pain associated with laryngeal botulinum toxin (BTX) injections and to determine factors associated with higher...
OBJECTIVES
To evaluate spasmodic dysphonia patients' perception of pain associated with laryngeal botulinum toxin (BTX) injections and to determine factors associated with higher pain scores relative to other included patients.
METHODS
Prospective cohort study. Adult patients with adductor spasmodic dysphonia that presented to a tertiary laryngology practice for BTX injections were recruited from March to July 2022. Patients completed the visual analog scale (VAS) pre-procedure to quantify predicted pain. Ten minutes post-procedure they completed VAS and the short form McGill Pain Questionnaire (SF-MPQ). Factors that may affect pain were extracted from charts. Descriptive statistics, univariate, and multivariate analyses were conducted (alpha = 0.05).
RESULTS
One hundred and nineteen patients were included (63 ± 14 yo, 26% Male). SF-MPQ reported mild pain (4.12 ± 4.05 out of 45) with a pain intensity of none to mild (0.70 ± 0.89 out of 5). Bilateral injections yielded significantly higher SF-MPQ scores (5.19 ± 4.66) than unilateral injections (3.30 ± 3.30) (p = 0.012). There was a significant VAS reduction from pre 28.9 ± 24.6 mm (out of 10 mm) to post 24.5 ± 22.3 (p < 0.001). On multiple regression analyses, receiving a bilateral injection significantly (p < 0.05) contributed to a model that predicted higher pre-VAS (p = 0.013). Bilateral injections (p < 0.05) and higher VHI-10 (p < 0.05) contributed to a model that predicted higher total SF-MPQ (p = 0.001) and affective SF-MPQ (p = 0.001) scores. Not being a professional voice user (PVU) significantly (p < 0.05) contributed to a model that predicted higher post-VAS (p = 0.008) scores.
CONCLUSIONS
BTX injections were well tolerated with low pain scores. Factors associated with higher relative predicted or experienced pain included bilateral versus unilateral injection, PVU status, and higher VHI-10.
LEVEL OF EVIDENCE
4 Laryngoscope, 134:240-246, 2024.
Topics: Adult; Humans; Male; Female; Dysphonia; Botulinum Toxins, Type A; Prospective Studies; Treatment Outcome; Pain; Laryngeal Muscles; Perception; Injections, Intramuscular
PubMed: 37409790
DOI: 10.1002/lary.30864 -
Journal of Voice : Official Journal of... Aug 2023To identify the presence of vocal fatigue and dysphonia risk in evangelical pastors and to verify associations of vocal fatigue with dysphonia risk and other factors.
OBJECTIVES
To identify the presence of vocal fatigue and dysphonia risk in evangelical pastors and to verify associations of vocal fatigue with dysphonia risk and other factors.
STUDY DESIGN
Cross-sectional observational study.
METHODS
Ninety-two evangelical pastors, professionally active, answered an on-line questionnaire divided in three steps. The first step consisted of data for the characterization of the sample. In the second stage, participants answered the vocal fatigue index questionnaire (VFI). Finally, they answered to the Brazilian Dysphonia Screening tool. A descriptive analysis of the data was performed along with Spearman's Correlation test between VFI factors and the three possible decision rules for the Brazilian Dysphonia Screening tool. A linear regression model was designed to verify predictive variables associated with the outcome "vocal fatigue".
RESULTS
Ninety male individuals were included. The average sample was off the threshold scores of tiredness and voice impairment, physical discomfort, improvement of voice symptoms with rest, and the total score of VFI. The dysphonia risk was low and was weakly negatively correlated with the improvement of voice symptoms with rest. The linear regression indicated that the presence of a current vocal complaint increases about four points in the VFI.
CONCLUSION
Evangelical pastors present symptomatology of vocal fatigue and low risk for dysphonia. However, the greater the improvement of voice symptoms with rest, the lower the risk for dysphonia. Furthermore, the presence of a current vocal complaint is associated with increased symptoms of vocal fatigue.
PubMed: 37567829
DOI: 10.1016/j.jvoice.2023.06.017 -
Cureus Sep 2023Horner's syndrome (HS) is a rare complication of thyroidectomy caused by damage to the oculosympathetic nerves. This article reports the case of a 29-year-old woman...
Horner's syndrome (HS) is a rare complication of thyroidectomy caused by damage to the oculosympathetic nerves. This article reports the case of a 29-year-old woman referred to the clinic with a newly diagnosed papillary thyroid carcinoma (PTC). Ultrasound studies were concerning for multiple thyroid nodules and an enlarged lymph node, confirmed by a computed tomography (CT) scan. Cytology results of fine needle aspiration (FNA) diagnostic for PTC showed tumors in the thyroid tissue and lymph node. The patient underwent a thyroidectomy and woke up with right-sided ptosis and miosis. Clinical follow-up revealed subjective ipsilateral anhidrosis. She also developed a low parathyroid hormone level and dysphonia, albeit they resolved after months. The patient still exhibits HS eight months after surgery. This paper reviews the literature and attempts to establish the most probable causal factor while providing implications for surgical teams to minimize HS occurrence in future thyroid surgeries.
PubMed: 37876407
DOI: 10.7759/cureus.45825 -
The Laryngoscope Nov 2023The aim of this study was to gain quantitative insights into the role of daily voice use associated with mild phonotrauma via the Daily Phonotrauma Index (DPI), a...
OBJECTIVE
The aim of this study was to gain quantitative insights into the role of daily voice use associated with mild phonotrauma via the Daily Phonotrauma Index (DPI), a measure derived from neck-surface acceleration magnitude (NSAM) and difference between the first two harmonic magnitudes (H1 - H2).
METHODS
An ambulatory voice monitor recorded weeklong voice use for 151 female patients with phonotraumatic vocal hyperfunction (PVH) and 181 female vocally healthy controls. Three laryngologists rated phonotrauma severity from each patient's laryngoscopy. Mixed generalized linear models evaluated the accuracy, sensitivity, and specificity of the original DPI trained on all patients versus a mild DPI version trained on only patients rated with mild phonotrauma. Individual contribution of NSAM and H1 - H2 to each DPI model was also evaluated.
RESULTS
Reliability across the laryngologists' phonotrauma ratings was moderate (Fleiss κ = 0.41). There were 70, 69, and 12 patients with mild, moderate, and severe phonotrauma, respectively. The mild DPI, compared to the original DPI, correctly classified more patients with mild phonotrauma (Cohen's d = 0.9) and less controls (d = -0.9) and did not change in overall accuracy. H1 - H2 contributed less to mild phonotrauma classification than NSAM for mild DPI.
CONCLUSIONS
Compared with the original DPI, the mild DPI exhibited higher sensitivity to mild phonotrauma and lower specificity to controls, but the same overall classification accuracy. These results support the mild DPI as a promising detector of early phonotrauma and that NSAM may be associated with early phonotrauma, and H1 - H2 may be a biomarker associated with vocal fold vibration in the presence of lesions.
LEVEL OF EVIDENCE
Level 4, case-control study Laryngoscope, 133:3094-3099, 2023.
Topics: Humans; Female; Voice Disorders; Case-Control Studies; Reproducibility of Results; Vocal Cords; Voice
PubMed: 37194664
DOI: 10.1002/lary.30750 -
Journal of Voice : Official Journal of... Feb 2024Smoking exerts certain damage to the voice, which affects sound characteristics. This study explored the effects of smoking, smoking time, and smoking amount on cepstral...
Smoking exerts certain damage to the voice, which affects sound characteristics. This study explored the effects of smoking, smoking time, and smoking amount on cepstral parameters. We collected the acoustic signals of sustained vowels in 301 participants (135 smokers and 166 nonsmokers). The cepstral parameters, including cepstral peak prominence (CPP), CPP standard deviation (CPP SD), low to high-frequency spectral ratio (L/H), low to high-frequency spectral ratio standard deviation (L/H SD), and voice disorder cepstral/spectral index of dysphonia (CSID), of the sustained vowels were investigated through the analysis of dysphonia in speech and voice (ADSV) application. The effects of smoking on these parameters were explored. The influences of smoking time and smoking amount on cepstral parameters were also analyzed by multiple linear regression. The CPP and L/H values in the smoking group were lower than those in the nonsmoking group (CPP: P < 0.001, L/H: P = 0.033) and negatively correlated with smoking time (CPP: R = 0.3828, P < 0.0001; L/H: R = 0.02996, P = 0.0447) and smoking amount (CPP: R < 0.4526, P < 0.0001; L/H: R = 0.08823, P = 0.00005). The CPP SD, L/H SD, and CSID values in the smoking group were higher than those in the nonsmoking group (CPP SD: P = 0.006, L/H SD: P = 0.034, CSID: P < 0.001) and positively correlated with smoking time (CPP SD: R = 0.03648, P = 0.0265, L/H SD: R = 0.09121, P = 0.0004, CSID: R = 0.01247, P = 0.1972) and smoking amount (CPP SD: R = 0.05495, P = 0.0062, L/H SD: R = 0.1316, P < 0.0001, CSID: R = 0.03851, P = 0.0225). Compared with other cepstral parameters, smoking time and smoking volume had the greatest impact on CPP (smoking time: R = 0.385, smoking amount: R = 0.443). This study confirmed that smoking has a significant effect on cepstral parameters. Compared with the cepstral parameters of nonsmokers, an increase in smoking time and smoking volume increases the abnormality of the cepstral parameters of smokers.
PubMed: 38310079
DOI: 10.1016/j.jvoice.2023.12.023 -
Alimentary Pharmacology & Therapeutics Mar 2024Laryngopharyngeal reflux has classically referred to gastroesophageal reflux leading to chronic laryngeal symptoms such as throat clearing, dysphonia, cough, globus... (Review)
Review
BACKGROUND
Laryngopharyngeal reflux has classically referred to gastroesophageal reflux leading to chronic laryngeal symptoms such as throat clearing, dysphonia, cough, globus sensation, sore throat or mucus in the throat. Current lack of clear diagnostic criteria significantly impairs practitioners' ability to identify and manage laryngopharyngeal reflux.
AIMS
To discuss current evidence-based diagnostic and management strategies in patients with laryngopharyngeal reflux.
METHODS
We selected studies primarily based on current guidelines for gastroesophageal reflux disease and laryngopharyngeal reflux, and through PubMed searches.
RESULTS
We assess the current diagnostic modalities that can be used to determine if laryngopharyngeal reflux is the cause of a patient's laryngeal symptoms, as well as review some of the common treatments that have been used for these patients. In addition, we note that the lack of a clear diagnostic gold-standard, as well as specific diagnostic criteria, significantly limit clinicians' ability to determine adequate therapies for these patients. Finally, we identify areas of future research that are needed to better manage these patients.
CONCLUSIONS
Patients with chronic laryngeal symptoms are complex due to the heterogenous nature of symptom pathology, inconsistent definitions and variable response to therapies. Further outcomes data are critically needed to help elucidate ideal diagnostic workup and therapeutic management for these challenging patients.
Topics: Humans; Laryngopharyngeal Reflux; Esophagitis, Peptic
PubMed: 38192086
DOI: 10.1111/apt.17858